| NPI | 1891316378 |
|---|---|
| Former Name | MAYRA LIZBETH DOMINGUEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 79522) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2014022221) |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2020-07-03 |